2019 Supplemental Drug List
|
|
|
- Morgan Griffin
- 5 years ago
- Views:
Transcription
1 2019 Supplemental Drug List This supplemental drug list was updated on August For more recent information or other questions, please contact Blue Cross Medicare Advantage Customer Service, at or, for TTY users, 711, 8 a.m. 8 p.m., local time, 7 days a week. If you are calling from April 1 through September 0, alternate technologies (for example, voic ) will be used on weekends and holidays. PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Y0096_BEN_GRP_SDL01_19NR_C
2 Your plan includes a supplemental drug benefit that provides coverage for a number of drugs that are excluded from coverage under the Medicare Part D program. You will pay your tier copay for drugs on this list. You can find the cost for each drug tier by checking the benefit chart in your Evidence of Coverage. Since supplemental drugs are excluded from the Part D program, the amount you spend on supplemental drugs generally does not count toward your Part D true out-of-pocket (TrOOP) expenses. These drugs do not qualify for lower Part D catastrophic copays. In addition, if you receive extra help to pay for your prescriptions, you will not get extra help to pay for these drugs. This is not a complete list of drugs covered by your plan. For the full list of your covered Part D drugs, please refer to your formulary or call customer service for additional questions. Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: QL = Quantity Limits ii
3 2019 Dosage Form Abbreviations Key act actuation mcg microgram ad adsorbed meq milliequivalent aepb aerosol powder blister mg milligram aer, aero aerosol ml milliliter app applicator mu million units ba, breath act, breath activ breath activated nebu nebules bau bioequivalent allergy units orally disintegr tab orally disintegrating tablets cap, caps capsules oin, oint ointment cart cartridge op, ophth ophthalmic chew tab chewable tablets osm osmotic conc concentrate pak pack conj conjugate, conjugated pf preservative-free crys crystals pfu plaque forming units deter deterrent pow, powd powder disint disintegrating pref, prefill prefilled dr delayed-release pttw patch twice weekly ec enteric coated ptwk patch weekly el, elu er, ext, extendrelease, extended, extended rel enzyme-linked immunosorbent assay recomb recombinant extended-release refrig refrigerate ext extract sl sublingual gm gram sol, soln solution gu genitourinary sqcm square centimeter hr hour supp, suppos suppositories ig immune globulin sus, susp suspension im intramuscular syr syringe inh, inhal inhalation tab, tabs tablets inj injection td transdermal ir index of reactivity tl translingual iv intravenous unt unit l liter va vaginal lf, lfu flocculation units vac vaccine liq, liqd liquid iii
4 2019 Drug Name Drug Tier Requirements/Limits Sexual Dysfunction CAVERJECT - alprostadil for inj 20 mcg CAVERJECT - alprostadil for inj 40 mcg CAVERJECT IMPULSE - alprostadil for inj kit 10 mcg CAVERJECT IMPULSE - alprostadil for inj kit 20 mcg CIALIS - tadalafil tab 2.5 mg QL (0 tablets/0 days) CIALIS - tadalafil tab 5 mg QL (0 tablets/0 days) CIALIS - tadalafil tab 10 mg QL (8 tablets/0 days) CIALIS - tadalafil tab 20 mg QL (8 tablets/0 days) EDEX - alprostadil for inj kit 10 mcg EDEX - alprostadil for inj kit 20 mcg EDEX - alprostadil for inj kit 40 mcg LEVITRA - vardenafil hcl tab 2.5 mg QL (8 tablets/0 days) LEVITRA - vardenafil hcl tab 5 mg QL (8 tablets/0 days) LEVITRA - vardenafil hcl tab 10 mg QL (8 tablets/0 days) LEVITRA - vardenafil hcl tab 20 mg QL (8 tablets/0 days) MUSE - alprostadil urethral pellet 125 mcg MUSE - alprostadil urethral pellet 250 mcg MUSE - alprostadil urethral pellet 500 mcg MUSE - alprostadil urethral pellet 1000 mcg PAPAVERINE-ALPROSTADIL - papaverine-alprostadil inj 0 mg/ ml-10 mcg/ml PAPAVERINE-ALPROSTADIL - papaverine-alprostadil inj 0 mg/ ml-20 mcg/ml PAPAVERINE-PHENTOLAMINE MES/ALPROSTADIL - papaverine-phentolamine-alprostadil inj mg/ml PAPAVERINE-PHENTOLAMINE MESYLATE - papaverinephentolamine inj 0-1 mg/ml PAPAVERINE/PHENTOLAMINE MES/ALPROSTADIL - papaverine-phentolamine-alprostadil inj mg/ml PHENTOLAMINE MESYLATE-ALPROSTADIL - phentolaminealprostadil inj 0.5 mg/ml-20 mcg/ml sildenafil citrate tab 25 mg QL (8 tablets/0 days) sildenafil citrate tab 50 mg QL (8 tablets/0 days) sildenafil citrate tab 100 mg QL (8 tablets/0 days) STAXYN - vardenafil hcl orally disintegrating tab 10 mg QL (8 tablets/0 days) STENDRA - avanafil tab 50 mg QL (8 tablets/0 days) STENDRA - avanafil tab 100 mg QL (8 tablets/0 days) STENDRA - avanafil tab 200 mg QL (8 tablets/0 days) VIAGRA - sildenafil citrate tab 25 mg QL (8 tablets/0 days) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 1
5 2019 Drug Name Drug Tier Requirements/Limits VIAGRA - sildenafil citrate tab 50 mg QL (8 tablets/0 days) VIAGRA - sildenafil citrate tab 100 mg QL (8 tablets/0 days) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 2
6 ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana. Si usted llama del 1 de abril al 0 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz). Blue Cross Medicare Advantage HMO plan in New Mexico, HMO and HMO-POS plans in Illinois, and PPO plans in Illinois, Montana, and New Mexico are provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). Blue Cross Medicare Advantage PPO plans in Texas are provided by HCSC Insurance Services Company (HISC). Blue Cross Medicare Advantage HMO plans in Texas are provided by GHS Insurance Company (GHS). Blue Cross Medicare Advantage HMO plan in Oklahoma is provided by GHS Health Maintenance Organization, Inc. d/b/a BlueLincs HMO (BlueLincs). HCSC, HISC, GHS, and BlueLincs are Independent Licensees of the Blue Cross and Blue Shield Association. HCSC, HISC, GHS, and BlueLincs are Medicare Advantage organizations with a Medicare contract. Enrollment in Blue Cross Medicare Advantage plans depends on contract renewal.
2017 Formulary Addendum Notice of Change (Prescription Drug Plans)
2017 Formulary Addendum Notice of Change (Prescription Drug Plans) WellCare Prescription Insurance, Inc. WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes that have occurred
2017 Formulary Addendum Notice of Change
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) WellCare Health Plans WellCare Access (HMO SNP), WellCare Liberty (HMO SNP), WellCare Reserve (HMO), WellCare Rx (HMO), WellCare Select
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Freedom Plan (HMO SNP) H5087-001 This is a listing of the changes that have occurred in our formulary.
2017 Formulary Addendum Notice of Change
017 Formulary Addendum Notice of Change (Medicare Advantage Plans) WellCare Health Plans WellCare Choice (HMO), WellCare Essential (HMO-POS), WellCare Value (HMO) This is a listing of the changes that
2017 Formulary Addendum Notice of Change
2017 Formulary Addendum Notice of Change (Prescription Drug Plans) WellCare Prescription Insurance, Inc. WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes that have occurred
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
207 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Plus Plan (HMO) H5087-002, H5087-07 This is a listing of the changes that have occurred in our formulary.
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Best Plan (HMO) H5087-005 This is a listing of the changes that have occurred in our formulary. Please
HOW TO USE THE FORMULARY
INTRODUCTION The information contained in the Willamette Valley Community Health (WVCH) WRAP/D-Excluded Formulary and its appendices is provided solely for the convenience of medical providers. WVCH does
2019 Formulary Update
MEDICARE ADVANTAGE BlueShield of Northeastern New York Formulary Update BlueShield of Northeastern New York has updated its formulary (drug list) since its original publication in January. This document
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates July 2018 TRADE NAME (generic name) or generic name ADVAIR DISKUS (fluticasone-salmeterol aer powder ba 100-50 mcg/dose) Brand Addition ADVAIR
Additional Drug Coverage
Additional Drug Coverage Additional prescription drug coverage Your plan includes extra coverage for certain supplies as shown below. These supplies are either not generally covered under Medicare Part
Additional Drug Coverage
Additional Drug Coverage Bonus Drug List Your employer group or plan sponsor offers a bonus drug list. The prescription drugs on this list are covered in addition to the drugs on the plan s drug list (formulary).
Changes to the 2018 BlueCross Secure SM (HMO) & BlueCross Total SM (PPO) Formularies
Changes to the 2018 BlueCross Secure SM (HMO) & BlueCross Total SM (PPO) Formularies BlueCross BlueShield of South Carolina may add or remove drugs from the formulary during the year. If we remove drugs
2014 Step Therapy Criteria (List of Step Therapy Criteria)
Criteria Last Updated: November 1, 2014 2014 Step Therapy Criteria (List of Step Therapy Criteria) PLEASE READ CAREFULLY: IEHP MEDICARE DUALCHOICE (HMO SNP) REQUIRES YOU TO FIRST TRY CERTAIN DRUGS TO TREAT
2018 Step Therapy (ST) Criteria
2018 Step Therapy (ST) Criteria Some drugs require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a
Health Partners Medicare Prime 2019 Formulary Changes
Health Partners Medicare Prime 2019 Formulary Changes Changes occur, for example, because new drugs come on the market, a drug is moved to a different cost-sharing level (tier), or a generic version becomes
2018 Formulary Notice of Change Prescription Drug Plans
2018 Formulary Notice of Change Prescription Drug Plans WellCare Prescription Insurance, Inc. Plans in all states: WellCare Classic (PDP) WellCare may add or remove drugs from our formulary during the
Additional drug coverage
Additional drug coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs as shown below. These drugs are either not generally covered under Medicare Part D or
Memorial Hermann Advantage HMO February 2019 Formulary Addendum
Memorial Hermann Advantage HMO February 2019 Formulary Addendum Changes may have occurred since the printing of your current Memorial Hermann Advantage HMO Formulary. Medications that may have been added
2016 FORMULARY ADDENDUM NOTICE OF CHANGE
2016 FORMULARY ADDENDUM NOTICE OF CHANGE (PRESCRIPTION DRUG PLANS) WELLCARE PRESCRIPTION INSURANCE, INC. WellCare Simple (PDP) WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes
Formulary Change Notice
Formulary Change Notice HealthPartners may remove drugs from our formulary (list of covered drugs) or add rules about whether and when certain drugs are covered during the year. The chart below contains
Additional drug coverage
Additional drug coverage Bonus Drug List Your plan sponsor (employer, union or trust) offers a bonus drug list. The prescription drugs on this list are covered in addition to the drugs on the plan s drug
Additional Drug Coverage
Additional Drug Coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs and supplies as shown below. These drugs are either not generally covered under Medicare
AETNA BETTER HEALTH January 2017 Formulary Change(s)
AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on February 1, 2017 Drug Name, Strength, Dosage Form IVERMECTIN 3 MG TABLET
Quarterly pharmacy formulary change notice
Provider Bulletin April 2018 This table is used by HealthKeepers, Inc. to indicate formulary changes applicable to all Anthem HealthKeepers Plus members. These changes were reviewed and approved at the
AETNA BETTER HEALTH January 2017 Formulary Change(s)
AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on March 1, 2017 Drug Name, Strength, Dosage Form ALFUZOSIN HCL ER 10
2017 Medicare Part D Formulary Change
2017 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
INFORMATION TOPIC: II-5 OR DEMONSTRATION: II-5. DOSAGE, MEASUREMENTS, AND DRUG FORMS (Lesson Title) OBJECTIVES THE STUDENT WILL BE ABLE TO:
LESSON PLAN: 5 COURSE TITLE: UNIT: II MEDICATION TECHNICIAN GENERAL PRINCIPLES SCOPE OF UNIT: This unit includes medication terminology, dosage, measurements, drug forms, transcribing physician s orders,
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary April 1, 2018 Updates. Formulary Alternatives
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select April 1, 2018 Updates Drug Name adapalene-benzoyl-peroxide Gel 0.1-2.5% (Brand = Epiduo ) prasugrel hcl (Brand = Effient ) vigabatrin pak 500 mg (Brand
Chapter 2 is a general introduction to the drug administration
Chapter 2 Safe and Accurate Drug Administration Chapter Overview Chapter 2 is a general introduction to the drug administration process. It introduces the student to the role of the person who administers
INFORMATION TOPIC: II-5 OR DEMONSTRATION: II-5. DOSAGE, MEASUREMENTS, AND DRUG FORMS (Lesson Title) OBJECTIVES THE STUDENT WILL BE ABLE TO:
LESSON PLAN: 5 COURSE TITLE: UNIT: II MEDICATION TECHNICIAN GENERAL PRINCIPLES SCOPE OF UNIT: This unit includes medication terminology, dosage, measurements, drug forms, transcribing physician s orders,
2018 Medicare Part D Formulary Change
2018 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
2019 List of Covered Drugs
2019 List of Covered Drugs Formulary ID: 19391 Version 10 Updated: 02/2019. If you have questions, please call First Choice VIP Care Plus at 1-888-978-0862 (TTY 711), seven days a week, 8 a.m. to 8 p.m.
LET S TALK PREVENTION
LET S TALK PREVENTION YOUR NO-COST PRESCRIPTION DRUGS FOR PREVENTIVE CARE Your health plan offers certain preventive service benefits at no cost to you. This means you don t have to pay a copay* or coinsurance,
Additional drug coverage
Additional drug coverage Additional prescription drug coverage Your plan includes extra coverage for certain drugs as shown below. These drugs are either not generally covered under Medicare Part D or
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary April 1, 2018 Updates. Formulary Alternatives
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select April 1, 2018 Updates Drug Name adapalene-benzoyl-peroxide Gel 0.1-2.5% (Brand = Epiduo ) prasugrel hcl (Brand = Effient ) vigabatrin pak 500 mg (Brand
2019 PHARMACY DIRECTORY
2019 PHARMACY DIRECTORY This is a brief explanation and overview of the pharmacies members can use to get their prescription drugs. In a continued effort to offer our members value, pharmacies may be added
Additional DRUG COVERAGE
Additional DRUG COVERAGE Bonus Drug List Your plan sponsor (employer, union or trust) offers a bonus drug list. The prescription drugs in this list are covered in addition to the drugs in the plan s formulary
Medicare Part D Drugs that Require Step Therapy Effective 12/01/2017
Medicare Part D Drugs that Require Step Therapy Effective 12/01/2017 Providers may call the Pharmacy Help Desk at 800-641-8921 for more information or questions about criteria. The formulary may change
Y0133_StepTherapyCriteria _C 10/18/18 Y0133_StepTherapyCriteria _C es 10/18/18
Step Therapy Grid Certain cost-effective drugs must be used before other more expensive drugs are covered. For example, certain brand-name medications will only be covered if a generic alternative has
Additional DRUG COVERAGE
Additional DRUG COVERAGE Additional prescription drug coverage Your plan includes extra coverage for certain drugs as shown below. These drugs are either not generally covered under Medicare Part D or
2019 LIST OF COVERED DRUGS (FORMULARY)
2019 LIST OF COVERED DRUGS (FORMULARY) Prescription drug list information UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) Toll-free 1-877-542-9236, TTY 711 8 a.m. - 8 p.m. local time,
Quarterly pharmacy formulary change notice
Provider Bulletin October 2018 Quarterly pharmacy formulary change notice The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus patients. The changes listed in the table
Notice of Mid-Year Changes to 2019 Paramount Enhanced Formulary
Notice of Mid-Year s to 2019 Paramount Enhanced Formulary Paramount Elite (HMO) may immediately remove a brand name drug on our List if we are replacing it with a new generic drug that will appear on the
You ll find the most up-to-date comprehensive version of our formulary on our website, Click on Drug Finder.
3/1/2018 Medicare Part D Formulary Change In an effort to cover the most needed, cost-effective prescriptions, the AlohaCare Advantage Plus (HMO SNP) Formulary is updated monthly. The following are drugs
2014 Quantity Limits (QL) Criteria
2014 Quantity Limits (QL) Criteria Certain drugs covered through your EmblemHealth Medicare HMO/PPO Medicare Plan are covered for only a limited quantity. We do this to ensure compliance with the US Food
SCHEDULE YOUR PREVENTIVE CARE VISIT Preventive care visits, or routine checkups, are important to your health.
We re in this together: uality Health Care Member FOCUS HAWAII 2018 ISSUE 1 SCHEDULE YOUR PREVENTIVE CARE VISIT Preventive care visits, or routine checkups, are important to your health. Why are preventive
2018 Formulary Update
MEDICARE ADVANTAGE BlueShield of Northeastern New York 2018 Formulary Update BlueShield of Northeastern New York has updated its formulary (drug list) since its original publication in January 2018. This
SCHEDULE YOUR PREVENTIVE CARE VISIT Preventive care visits, or routine checkups, are important to your health.
We re in this together: Quality Health Care Member FOCUS EASY CHOICE 2018 ISSUE 1 SCHEDULE YOUR PREVENTIVE CARE VISIT Preventive care visits, or routine checkups, are important to your health. Why are
Formulary. BlueMedicare SM Comprehensive
BlueMedicare SM Comprehensive Formulary BlueMedicare Classic (HMO) H1035-017,018 BlueMedicare Classic Plus (HMO) H1035-022 BlueMedicare Select (PPO) H5434-002 This formulary was updated on 12/31/2018.
2018 Step Therapy Criteria (List of Step Therapy Criteria)
Step Therapy Criteria Last Updated: March 20, 2018 Effective Date: April 1, 2018 2018 Step Therapy Criteria (List of Step Therapy Criteria) PLEASE READ CAREFULLY: IEHP DUALCHOICE CAL MEDICONNECT PLAN (MEDICARE-MEDICAID
ICP Formulary Updates
ICP Formulary Updates July 2017 TRADE NAME (generic name) adapalene cream 0.1% 2017-07-01 Removal adapalene gel 0.3% 2017-07-01 Removal adefovir dipivoxil tab 10 mg 2017-07-01 Removal ADVAIR DISKUS (fluticasone-salmeterol
Quarterly pharmacy formulary change
Medi-Cal Managed Care L. A. Care Major Risk Medical Insurance Program Provider Bulletin The formulary changes listed in the table below were reviewed and approved at our first-quarter 2018 Pharmacy and
Quarterly pharmacy formulary change notice
Quarterly pharmacy formulary change notice The formulary changes listed in the table below were reviewed and approved at our second quarter 2018 Pharmacy and Therapeutics Committee meeting. Effective October
UPDATE Ohana QUEST Integration Medicaid
UPDATE Ohana QUEST Integration Medicaid Preferred Drug List June 29, 2015 Dear Provider: At the June 04, 2015 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes
WellCare Signature (PDP) and WellCare Classic (PDP) Formulary Addendum
WellCare Signature (PDP) and WellCare Classic (PDP) Formulary Addendum This is a listing of the changes that have occurred in our formulary. Please carefully review these changes and call WellCare if you
Delta Dental benefit summary
Delta Dental benefit summary To find a, visit deltadentalin.com/finda and use the search tool in the blue box for Medicare Advantage PPO and Medicare Advantage Premier Providers. You may also call customer
BlueLink TPA FlexRx Updates
BlueLink TPA FlexRx Updates April 2018 TRADE NAME (generic name) or generic name abacavir sulfate soln 20 mg/ml (base equiv) Generic Addition, generic for ZIAGEN alclometasone dipropionate cream 0.05%
Expand your employees health care literacy by educating them about safe and simple ways to dispose of unused or expired prescription drugs.
1 GRAB-AND-GO EMPLOYEE EDUCATION CAMPAIGN HOW-TO GUIDE National Prescription Drug Take-Back Day Expand your employees health care literacy by educating them about safe and simple ways to dispose of unused
Quarterly pharmacy formulary change notice
MEDICAID PROVIDER BULLETIN October 2018 The formulary changes listed in the table below were reviewed and approved at the second-quarter 2018 Pharmacy and Therapeutics Committee meeting. Effective October
2011 Formulary Addendum
2011 Formulary Addendum This is a listin of the chanes that have occurred in our formulary. Please carefully review these chanes and call WellCare if you have any questions. Date of Chane: 03/01/2011 Formulary
2019 Formulary. (List of Covered Drugs)
Capital Health Plan Retiree Advantage (HMO) 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary ID 00019182,
2018 Formulary. (List of Covered Drugs)
Capital Health Plan Retiree Advantage (HMO) 2018 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary ID 00018125,
Regence makes it easy
Regence makes it easy Regence BlueShield is changing the way people experience health care by removing friction from the system and making it easier to navigate. When you have Regence as your health plan,
Quarterly pharmacy formulary change notice
MEDICAID PROVIDER BULLETIN March 2019 Quarterly pharmacy formulary change notice The formulary changes listed in the table below were reviewed and approved at the fourth quarter pharmacy and therapeutics
2018 CareOregon Advantage Part D Formulary Changes
2018 CareOregon Advantage Part D Formulary Changes Abbreviations: AGE = Age Restriction; PA = Prior Authorization Required; QL = Quantity Limit; ST = Step Therapy Required; LD = Limited Distribution; BvD
IlliniCare Health MMAI (MMP) 2016 Step Therapy Criteria
IlliniCare Health MMAI (MMP) 2016 Step Therapy Criteria Instructions: 1. With this file, at the top, click Edit, then click Find. 2. In the Find box type the name of the medication you want to find. 3.
Aetna Better Health of Illinois Medicaid Formulary Updates
October 2017 o DOXYLAMINE SUCCINATE 25mg-QL o DULOXETINE CAP 40MG DR-QL o GUANFACIN ER TABS (all strengths)-ql o TOBRAMYCIN NEBU SOLUTION- PA August 2017 Aetna Better Health of Illinois Medicaid 2017 Formulary
Phosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary
Phosphodiesterase Type 5 Inhibitors Quantity Limit Program Summary FDA APPROVED INDICATIONS AND DOSAGE 1-4,23 Agent FDA Approved Dosage and Administration Indication Cialis (tadalafil) (ED) ED; As needed:
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates April 2018 TRADE NAME (generic name) or generic name Brand/Generic Description of Change abacavir sulfate soln 20 mg/ml (base equiv) Generic
Aspirin. Iron Supplements
Interim Final Rules for Non-Grandfathered Group Health Plans and Health Insurance Issuers Coverage of Preventive Services Under the Patient Protection and Affordable Care Act Aspirin Aspirin to Prevent
Formulary. BlueMedicare SM Comprehensive
BlueMedicare SM Comprehensive Formulary BlueMedicare Complete Rx (PDP) S5904-002 BlueMedicare Group PPO (Employer PPO) BlueMedicare Group Rx (Employer PDP) This formulary was updated on 12/31/2018. For
Emblem Medicaid 3Q18 Formulary Updates
ALKERAN 2 MG TABLET Removed from Formulary 7/9/2018 AMITIZA 24 MCG CAPSULES Removed from Formulary 7/9/2018 AMITIZA 8 MCG CAPSULE Removed from Formulary 7/9/2018 avo cream topical emulsion Removed from
2018 Step Therapy Criteria (List of Step Therapy Criteria)
Criteria Last Updated: October 05, 2017 Effective Date: January 1, 2018 2018 Step Therapy Criteria (List of Step Therapy Criteria) PLEASE READ CAREFULLY: IEHP DUALCHOICE CAL MEDICONNECT PLAN (MEDICARE-
SUMMARY OF BENEFITS HEALTHTEAM ADVANTAGE PLAN I (PPO) HEALTHTEAM ADVANTAGE PLAN II (PPO)
2017 SUMMARY OF BENEFITS HEALTHTEAM ADVANTAGE PLAN I (PPO) HEALTHTEAM ADVANTAGE PLAN II (PPO) HealthTeam Advantage, a product of Care N Care Insurance Company of North Carolina, Inc., is a Medicare Advantage
2019 Drug List Negative Changes
2019 Drug List Negative Changes Updated 03/26/2019 If you are taking a drug that is removed from the formulary (also known as the Drug List), we will tell you. We will also tell you if we add any restrictions
Partners Notice of Change March 2017
New Added Products: Effective 3/1/2017 Drug Reason Tier Restrictions abacavir 600 mg-lamivudine 300 QL ADRENACLICK 0.15 MG/0.15 ML INJECTION,AUTO- INJECTOR ADRENACLICK 0.3 MG/0.3 ML INJECTION, AUTO- INJECTOR
Quarterly pharmacy formulary change notice
Provider update Quarterly pharmacy formulary change notice Summary: The formulary changes listed in the table below were reviewed and approved at our first-quarter 2018, Pharmacy and Therapeutics Committee
Access Network Directory Idaho
Access Network Directory Idaho Introduction 1 Introduction The following is a list of health care providers in this area who are in the Cigna network. Some providers may have been added or removed from
2019 Pharmacy Directory
2019 Pharmacy Directory This Pharmacy Directory was updated on 02/01/2019 This directory is for: Denver County Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory
Additional drug coverage
Additional drug coverage Bonus Drug List The North Carolina State Health Plan for Teachers and State Employees offers a bonus drug list. The prescription drugs in this list are covered in addition to the
NOTIFICATION OF FORMULARY CHANGES
NOTIFICATION OF CHANGES The following summary describes changes to the 2018 Presbyterian Senior Care (HMO)/(HMO-POS), Presbyterian MediCare PPO and formularies. The formulary may change at any time. You
BlueMedicare HMO Benefit Schedule for. Dental Care Services Hearing Services Vision Care Services.
www.bluemedicarefl.com BlueMedicare HMO 2017 Benefit Schedule for Dental Care Services Hearing Services Vision Care Services A Medicare Advantage Dental, Hearing and Vision Benefit Health coverage is offered
Member frequently asked questions
Magellan Complete Care of Virginia, a Medallion 4.0 program Member frequently asked questions ABOUT MEDALLION 4.0 What is Medallion 4.0? Medallion 4.0 replaces the Medicaid health plan known before as
Managing Symptoms after Prostate Cancer Sexual Side Effects. Changes in a man s sex life are common and can be managed.
Managing Symptoms after Prostate Cancer Sexual Side Effects Changes in a man s sex life are common and can be managed. Prostate cancer and its treatment often bring changes in a man s sex life, especially
See Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: CP.HNCA.01 Effective Date: 11.16.16 Last Review Date: 04.18 Line of Business: Commercial - HNCA Revision Log See Important Reminder at the end of this policy for important
3 Tier Formulary Additions
3 Tier Formulary Additions Drug Name Tier Category Management ACCU-CHECK GUIDE ME GLUCOSE METER 3 Diabetic Supplies Step Therapy applies pyridostigmine bromide 60mg/5ml syrup 1 Antimyasthenic Agents New
APREPITANT ARMODAFINIL BELSOMRA BUPAP BUPRENORPHINE HCL BUTALBITAL-ACETAMINOPHEN BUTALBITAL-APAP-CAFF-COD BUTALBITAL-APAP-CAFFEINE
APREPITANT Aprepitant Oral Capsule 125, 40, 80 Aprepitant Oral Capsule 80 & 125 Quantity Limit: 8 EA Per 30 Days Quantity Limit: 12 EA Per 30 Days ARMODAFINIL Armodafinil Oral Tablet 150, 200, 250, 50
South Texas College Associate Degree in Nursing. RNSG 1262 Clinical 1. Math and Dosage Calculations Module
South Texas College Associate Degree in Nursing RNSG 1262 Clinical 1 Math and Dosage Calculations Module Study this Module and answer all the practice questions. Show your computation and write the final
Aetna Better Health Illinois Premier Plan. November 2015 Formulary Updates. October 2015 Formulary Updates
Aetna Better Health Illinois Premier Plan November 2015 Formulary Updates desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg RIVASTIGMINE DIS 13.3/24; QL (30 patches/30 days) RIVASTIGMINE DIS 4.6MG/24;
WellCare s South Carolina Preferred Drug List Update
WellCare s South Carolina Preferred Drug List Update This is a list of changes to our preferred drug list. These are a result of the latest WellCare Pharmacy & Therapeutics meeting held on 09/21/2017.
Drugs That Require Step Therapy (ST)
Saver Drugs That Require Step Therapy (ST) In some cases, Express Scripts Medicare (PDP) requires you to first try certain drugs to treat your medical condition before we will cover another drug for that
FORMULARY CHANGE NOTICE 2008 JULY
FORMULARY CHANGE NOTICE 2008 JULY Drug Name Dosage Form Strength Alternative Medicine* Formulary Formulary Change and Reason Status of Alternative Medication Updated Status On Formulary STARLIX TABS 120MG
Pharmacology Drug Dosage Calculations
Pharmacology Drug Dosage Calculations Overview Abbreviations Metric Conversions Desired Dose Concentrations Drip Rates Medications (Dopamine and Lidocaine) Abbreviations cc- cubic centimeter DD- Desired
ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Golden State Medicare Health Plan, Golden (HMO) Last Updated: 09/01/2018
Step Therapy Golden State Medicare Health Plan, Golden (HMO) Last Updated: 09/01/2018 ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG